Around a year ago, I consulted a dermatologist regarding a persistent skin allergy. He told me in no uncertain terms that my ailment was related to stress and weight. I was instructed to practise meditation or yoga and walk every day for at least 45 minutes. I was also told to stop table sugar and follow a healthy diet. I nodded solemnly and came home all charged up. For a person who’s only walking is to the fridge and back, I had no clue how to bring in all these alarming changes to my routine. Unsurprisingly, it took four days for my enthusiasm to die a quiet and embarrassed death. My allergy though is more obstinate and rears its head now and then.
When it comes to implementing lifestyle changes suggested by doctors, my woe-filled tale will resonate with many. Doctors, especially specialists, routinely dole out advice to patients with lifestyle-related diseases such as heart ailments, hypertension and diabetes. They cannot be expected to do a follow-up of every person to check if they have tweaked their lifestyle. The problem is, no one is doing this follow-up.
The first P: personalised
“Ideally, lifestyle and dietary advice must be customised according to the individual’s job, where he stays, how he travels, what he eats at home, the practical difficulties he faces, and so on,” says Dr Gopi Aniyathodiyil, Consultant Interventional Cardiologist, Fortis Hospital, Bengaluru. We all know that rarely happens, if ever.
For instance, if a person has been diagnosed with hypertension and told to drastically reduce his sodium intake, and it may be that he eats every day in an office canteen, he has no control over how much salt his curries contain. Dr Alpesh Jain, Consultant Diabetologist at Masina Hospitals and Lifespan Diabetes Clinic, Mumbai, recalls a case of an overweight woman in her 40s who had developed hypertension. He advised her to follow a strict exercise programme. She said she could not because she was a single mother who had to take care of her child as well as work in an office far from home, which meant she left home at 9 and returned only in the late evening, which left her with no time for exercise of any sort.
The second P: pause
Evidently, doctors too realise there is a problem. “No one is really bridging this gap. Ideally, every hospital should have a dedicated rehabilitation and education department with qualified nurses, physiotherapists, and dieticians working in tandem. This department should follow up on each patient, customise advice and be there to answer queries every time,” says Dr Aniyathodiyil.
However, since no such department exists, he feels doctors can only reinforce their message when the person next visits them. Another problem doctors face is resistance. “Sometimes, patients and their well-wishers suspect the hospital has some money-making agenda if we insist on a follow-up… it is a delicate balance we have to maintain,” he rues.
- Keep it sustainable: To find what works for you, you have to take into account your environment, current lifestyle, work schedule, dietary practices and monetary circumstances. A single course of action that falls outside these parameters will eventually peter out.
- Try different things: Diet and lifestyle changes will involve a whole lot of research as well as trial and error. Don’t get disheartened in the process.
- Look to the ‘bridge’ professionals: Find a trustworthy dietician or physiotherapist. Do not hesitate to ask for their qualifications.
- Involve your family: Let them know of the dietary changes you are planning to bring. Ask for their help to keep you motivated while following an exercise programme.
- (Inputs by Rahul Gopal and Dr Aniyathodiyil)
What Dr Aniyathodiyil does not spell out loud, Dr Alpesh does. “This ‘advice gap’ is being filled by WhatsApp forwards, internet quacks and self-declared health gurus. This ‘annoyance’ has now reached epidemic proportions and doctors are having to pit their professional knowledge against click-bait websites and unqualified influencers.” He says he has had to deal with people who despite detailed instructions about their diet come back after a few weeks armed with WhatsApp forwards about how good (or evil) a particular food is and demand to know why the doctor had advised them against eating it. Patients routinely fall for market-driven counsel (often with poor scientific backing) such as eating quinoa by the bucketful, shifting to olive oil, or replacing good old eggs with the latest influencer favourite quail’s eggs!
The third P: preventive
One assumes such situations arise because lifestyle and dietary changes are a matter of habit formation and willpower (or the lack of it). However, this is not always the case. People are, more often than not, simply clueless about how to implement the suggested changes, where to fit in the exercise, how to form habits that are viable and how not to fall back on comfortable and potentially dangerous lifestyle practices (such as bingeing and smoking). And most importantly, whom to trust when it comes to the nitty-gritty of following the doctors’ advice without having to run to his clinic for every little doubt.
Chennai-based sports nutritionist and strength and conditioning coach Rahul Gopal is one of the few people trying to fill this gap. Rahul is co-founder of The Formula, a lifestyle clinic that creates customised nutrition and exercise protocols for its clients. Rahul’s journey began after a few routine blood tests revealed he had pre-diabetes; his thyroid and cholesterol markers were not great either. By overhauling his lifestyle, as he puts it, he managed to not only lose 16 kg over a period of time but also ensure his pre-diabetes was reversed. “Expecting doctors to worry about implementation of their advice is unfair and is not good use of their precious time. We desperately need qualified ‘middlemen’ who can do the necessary follow through,” says Rahul.
Having said that, Rahul believes ultimately the motivation for any overhauling must come from within: “You cannot outsource your health; you have to take control. If you have to live well, you will have to do it.”